Ontario Health Plan for an Influenza Pandemic Overview

1
Ontario Health Plan for an Influenza Pandemic
Overview

• Emergency Management Unit
• Ministry of Health and Long-Term Care
• June 2005

2
Table of Contents

• Background
• Ontario Health Plan for an Influenza Pandemic
  (OHPIP) Overview
• Context for Influenza Pandemic
• Potential Impact in Ontario
• Ethical Framework
• Roles and Responsibilities
• Planning Assumptions
• Surveillance
• Vaccines and Antivirals
• Health Services, including Occupational Health
  and Safety
• Emergency Response
• Public Health Measures
• Communications
• Highlights New in the Next Version of OHPIP
  (June 2005)
• Future Planning/Implementation Issues

3
Background

• Canadian Pandemic Influenza Plan released
  February 2004
• Ontario Health Pandemic Influenza Plan released
  end of May 2004 following series of health
  stakeholder consultations
• Work underway to (1) further develop OHPIP for
  version 2 release in June 2005 and (2) develop
  government-wide Coordinating Plan for Pandemic
  Influenza (led by Emergency Management Ontario)

4
OHPIP Overview
The following slides provide an overview of key
components of the current Ontario plan

• Goals
• Minimize serious illness and overall deaths
  through appropriate management of Ontarios
  health care system
• Minimize societal disruption in Ontario as a
  result of influenza pandemic
• Strategic Approach
• Be ready establish comprehensive influenza
  pandemic contingency plans at provincial and
  local level
• Be watchful practice active screening and
  monitor emerging epidemiological and clinical
  information
• Be decisive act quickly and effectively to
  manage the epidemic
• Be transparent communicate with health care
  providers and Ontarians

5
Context for Pandemic Influenza Planning

• Activities correspond to new World Health
  Organization pandemic phases (Inter-pandemic,
  Pandemic Alert and Pandemic)
• Aligned with direction in Canadian Pandemic
  Influenza Plan (CPIP)
• Provides detail on federal, provincial and local
  roles/responsibilities and commitments
• Identifies expectations re. local planning
  activities
• Outlines health emergency management approach
  (e.g. use of Incident Management System and
  coordination with EMO/other levels of government)
• Ethical framework for decision-making underscores
  approach
• Evergreen document that will continue to be
  updated with emerging clinical, epidemiological,
  and operational information

6
Ethical Framework

• Open and Transparent decision-making process
  open to scrutiny and the basis for decisions
  explained
• Reasonable decisions should be based on evidence
  and be made by people who are credible and
  accountable
• Inclusive decisions should be make with
  stakeholder views in mind and stakeholder should
  have opportunities to be engaged in process
• Responsive decisions should be revisited and
  revised as new information emerges and
  stakeholder have opportunities to voice any
  concerns they have about decisions
• Accountable mechanism should be established to
  ensure that ethical decision-making is sustained
  throughout the epidemic

7
Roles and Responsibilities
Each level of government will operate within the
authority of their jurisdiction and work
collaboratively to ensure integration of
provincial and local responsibilities within the
framework of the Canadian, Ontario and local
pandemic influenza plans to ensure a seamless
response

• Federal Government
• Vaccine/antiviral procurement and supply to
  provinces/territories
• International liaison with World Health
  Organization (WHO) and other national agencies
  (e.g. US Centres for Disease Control)
• Provincial Government
• Establishment of provincial pandemic plan aligned
  with CPIP in consultation with Ontarios health
  stakeholders
• Outline provincial commitments and activities for
  pandemic planning and response
• Provide overall direction and advice on local
  preparedness and response activities for pandemic
  influenza (no direct statutory authority to
  require compliance)
• Local Government
• Led by local public health units, establish local
  pandemic influenza contingency plans congruent
  with the provincial influenza pandemic plan
• Provide input, advice and required surveillance
  data to provincial health authorities

8
Planning Assumptions

• One three month lead time with additional waves
  likely
• Vaccine likely unavailable for first wave/limited
  supply thereafter
• Antiviral supply limited and focused on priority
  groups
• Centralized supply distribution of personal
  protective equipment (PPE), vaccines/antivirals,
  and other equipment through Ontario Government
  Pharmacy and pre-established distribution points
• Health Human Resources (HHR) availability during
  a pandemic severely curtailed (reduced by 40
  60 reflecting attack rate, family
  responsibilities, reluctance to be at risk) HHR
  planning to use skills-based vs.
  discipline-based approach
• Health services severely curtailed to focus on
  necessary services
• Emergency Management Ontario to provide
  provincial emergency management/EMU PHD to
  coordinate response with health sector
• Provincial Infectious Diseases Advisory Committee
  (PIDAC) to provide expert scientific/technical
  advice during pandemic

9
Surveillance

• The surveillance section provides information on
• Monitoring influenza-like illness (ILI) to detect
  the pandemic strain early in Ontario through a
  variety of mechanisms (Febrile Respiratory
  Illness surveillance, FluWatch Program,
  laboratory diagnostic testing)
• Comparing new strains with vaccine composition
• Tracking the occurrence and severity of outbreaks
  (based on WHO pandemic phases)
• Sharing surveillance information with responders
  to help guide efforts to track, contain and treat
  the disease

10
Vaccines and Anti-virals

• Provides information on
• Components of effective antiviral and vaccine
  programs (security of supply, ability to store,
  allocate and administer vaccine and antiviral
  supplies efficiently and appropriately,
  monitoring safety/efficacy and any adverse
  events)
• Emergency Mass Prophylaxis Plan
• Provincial/federal efforts to secure
  vaccine/antiviral supply for Ontario
• Describes priority groups identified by the F/P/T
  Pandemic Influenza Committee
• Vaccine Priority Groups
• Frontline health care workers and key
  decision-makers
• Essential health care providers, public health
  responders essential health support services
• Essential service workers
• Persons at high risk of fatal outcomes (e.g.
  elderly, immunocompromised)
• Healthy adults
• Children 24 months to 18 years of age

11
Vaccines and Anti-virals

• Anti-viral Priority Groups
• Treatment (must be administered within 48 hours
  of onset of symptoms)
• Persons hospitalized for influenza
• Ill health care workers and first
  responders/emergency service workers
• Ill high-risk persons in the community
• Ill high-risk persons in institutions
• Prophylaxis
• Frontline health care workers and key
  decision-makers
• Remaining health care workers
• Emergency/essential service workers
• High-risk residents of institutions
• Person at high risk hospitalized for illness
  other than influenza

12
Public Health Measures

• This section outlines required public health
  measures to help limit the spread/impact of an
  influenza pandemic, including
• Individual measures such as the use of PPE, case
  and contact management, isolation and individual
  activity restriction
• Community measures such as cancelling public
  gathering and closing schools
• Ensuring consistency in the provincial approach
  to influenza containment measures in
  collaboration with local public health units

13
Health Services

• Health services outlines approach/activities to
• Ensure health settings maintain appropriate
  occupational health and safety standards through
  use of PPE and infection control measures
• Identify necessary health services that will be
  provided during a pandemic and services that can
  be curtailed
• Identify Health Human Resources required during a
  pandemic and how they will be deployed (focusing
  on necessary skill sets)
• Develop an effective system for purchasing,
  storing and distributing equipment and supplies
  before and during a pandemic
• Implement admission/discharge and triage criteria
  for individuals ill with influenza
• Guide community, public health and hospital
  laboratory services

14
Emergency Response

• This section outlines the provincial health
  emergency response, including
• Coordination/collaboration between emergency
  response personnel and health authorities in
  pandemic planning and response activities
  (communication mechanisms, clarification of
  roles/responsibilities, etc.)
• Establishment of Business Continuity/Continuity
  of Operations Plans to ensure continuity of
  necessary services
• Identification of emergency response resources
  that can be mobilized to help the health sector
  respond to a pandemic (including support from
  Emergency Management Ontario and other
  Ministries)
• Activation of the Ministry Emergency Response
  Plan

15
Communications

• This section outlines communications measures to
• Ensure that Ontario is prepare to respond to
  public and health care provider communication
  needs
• Educate Ontarians about the pandemic plan
• Provide consistent, coordinated and effective
  public and provider communications
• Ensure health care providers have access to
  transparent, access accurate real time
  information to help them respond
• Ensure mechanisms for health care providers to
  share information with each other and
  decision-makers to continuously improve Ontarios
  pandemic response

16
Highlights New in the Next Version of OHPIP

• Operational Measures (pre-hospital, community,
  hospital)
• Admission/discharge criteria for hospitals and
  critical care units
• Clinical management guidelines
• Occupational Health and Safety/Infection Control
  measures
• Role of TeleHealth, Infoline, CCACs in triaging
  people ill with influenza
• Necessary Health Services Delivery Framework
• Laboratory guidelines (for public health,
  community and hospital laboratories)
• Algorithm for assessing the quantity/type of PPE
  and clinical supplies required in a range of
  health care settings
• Public Health Measures
• Emergency Mass Immunization Plan Vaccinators
  Manual
• Necessary Public Health Programs Delivery
  Framework
• Enumeration Tool for determining
  vaccine/antiviral supply requirements
• Communications
• Fact Sheets backgrounders for public and health
  stakeholders
• Communications plan including Information Cycle

17
(No Transcript)
18
Feedback to Date

• Positive response to new layout, cover design,
  use of diagrams, more user friendly
• Strong recommendation for in-depth Table of
  Contents or mapping
• Support for ethical framework some question re
  practicality of appeal mechanism
• Support for Occupational Health/Infection
  Prevention and Control Measures During the
  Pandemic Period
• Role for non-acute and community sectors needs
  enhancement

19
Release of Plan

• Planned release in April/May deferred to allow
  for greater content
• Release planned for week of June 13
• Stakeholder support in place
• Method of release not finalized

20
Future Planning Implementation Issues

• Financial
• Costing at provincial and local levels not yet
  determined
• Provincial sources of funding for pandemic
  influenza preparedness (supplies, capital
  equipment, etc) not identified
• Emergency funding/compensation policy for
  workers, businesses during pandemic not
  established
• Other
• Additional operational, public health and
  communications work/products
• Consultation with primary care/community health
  providers re. role in a pandemic
• Broadening provincial health influenza pandemic
  plan to government-wide Coordinating Plan for an
  Influenza Pandemic under the auspices of EMO
• Managing public expectations balancing fear and
  complacency
• Development of workplan for next iteration